CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 5.000000 375.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 34.500000 2587.5000 75.0000
Subtotal (Total Children Is Unduplicated) 25 39.500000 2962.5000 75.0000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 263.000000 6575.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 30.000000 1500.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 5.000000 359.8000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 7 13.500000 971.4600 71.9600
PHY-97110HM-PT SESSION BY PT ASST 6 15.500000 892.1800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 19.000000 1367.2400 71.9600
Subtotal (Total Children Is Unduplicated) 12 346.000000 11665.6800 33.7158
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Total 385.500000 14628.1800 37.9460
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Number of Children (Unduplicated) With at Least One Service 37
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Center 52
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
25 39.500000 2962.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 25 39.500000 2962.5000 0.0000
Center 57
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 3 7.500000 539.7000 539.7000
H 0 0.000000 0.0000 0.0000
T 1 2.000000 115.1200 115.1200
63 336.500000 11010.8600 11009.9400
Other 0 0.000000 0.0000 0.0000
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Total 67 346.000000 11665.6800 11664.7600